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Blog Posts in March 2018

Hello PRI family! I just returned from the great Northeast in Maine where I enjoyed teaching a Pelvis Restoration course with a diverse group of movement scientists from many professions.

Many thanks to the team at Coastal Orthopedics and Sports Medicine Physical Therapy for welcoming PRI into their beautiful clinic. Special thanks to Brian Bisson for leading the hosting effort and taking time to make my experience in fluid, top to bottom, so we could stay focused on restoring pelvis function. Thank you also for Michael Mullins, PTA, ATC, PRC for continuing to be an ambassador for the science of PRI in the Northeast and beyond, for putting me up and for the best scallops I've ever had! A+ for all hosts!

This course was filled with eager clinicians who were particularly interested in how to integrate a pelvis with a L AIC and/or a PEC overlay so their clients can return to full function and meet their functional and athletic goals. There was a good discussion and a long span of time taken demonstrating about how to reposition a PEC patient effectively from day one with focus on instant clinical application for a variety of settings. There were many with excellent questions about facilitation techniques and what muscles specifically are involved on which side and how each of said lengthened or shortened state muscle affects each quadrant of the inlet and the outlet--a very intuitive group!

Thank you Kyle Neagle DC, Amy McManus DPT, CSCS, Rick Sirois MS, LATC, CSCS, Sarah Coughlin LMT and others for your help with modeling patterns during lab demonstrations. What a thorough job this group did during lab demonstrations of both tests and techniques! Looking forward to seeing this group of learners in PRI circles for years to come, thanks to each for your attention and learning effort last weekend!

As an instructor, it so fun to be able to teach close to home and have a "home game." I had the pleasure to work with a great group of movement professionals from a variety of backgrounds. It was great to have Mark Cibrario host us for the weekend at his gym, The Trainers Club. It was also so fun to have Ieve Deleon, PT, in attendance. Ieve and I worked together for 5 years, and having her in the audience was very special.

Every course has an opportunity to be lead by the attendees based on their questions. And the questions we had this weekend were on point, while giving us the opportunity to expand our concepts, and still stay on task to achieve our educational goals. My thanks to Michael DuBois, Gena Vernon-Davis, Ninna Wang, Andrew Eliszewski, Ryan Levonyak, and Brad Thurman, among others. We had so many contributors to our successful weekend. Kathryn Lehner and Kyle Tynan were very kind to let us learn from them and be our models for the weekend.

The fun part of the weekend was our lab time. We were able to spend a lot of time in lab working on positional tests, and the Hruska Abduction and Adduction Lift tests, We also were able to work our way through activities related the management of an individual with a pathological L AIC presentation, from activation to inhibition.

"Home games" are infrequent, and to have the opportunity to have had such a great group to work with, learn from, and interact with was truly the best part of the weekend!

Exo's in Frisco, TX was the location for Postural Respiration last weekend. This course was attended by students from California, New York, New Jersey and especially Texas! Lab assistant James Guzman, PTA, MS, CSCS, PRC came up from Houston and was an essential component to the success of this weekend and enhancing the experience for all students. This class had 1/3 students brand new to PRI ,and for most of the rest participating, this was their first intro to Postural Respiration. The feed-back from the class was that Respiration really reinforced Pelvis and Myokin and reinforced the questions "can a femur adduct, can a ribcage rotate, and can a pelvis and ribcage separate movement to reciprocate and alternate?" These students took the concepts of the didactic material and applied their experience to PRI principles through testing, re-positioning and applying manual techniques. Through the process, they discovered how the PRI principle of lateralization actually occurs and what makes it so important in assessing and providing not only bilateral movement but tri-planer respiratory function as well. As always, Superior T-4 is a hot topic and lab assessment and demonstration helped the entire class discriminate between a patterned LAIC/RBC individual and one that is compensating with scalenes aided by the little muscle the could and will, subclavius. One of the huge take-away's was how Superior T-4 Syndrome affects orientation of a neck and that the bridge from respiration to cervical spine in testing is the Cervical Axial Rotation test. The class got a chance to hear Taylor Lewis MA CSCS, PRT, RKC II discuss PRI applications with Cystic Fibrosis. Thank you Brittani Cookinham, PT for all of your help in hosting this course. And thanks to all of the students, Carmela, Dana, Stephanie, Kelli, Michelle, Mario, TJ, Allison, Stephen, Alexander, Hsuan and everyone else for their spot-on questions and enthusiasm.

Donna Behr PT, MS, DPT, PRC has done it again! She hosted Postural Respiration at a new location in Needham, Massachusetts and attendees from all walks and locales came to learn the wonderful science that is PRI! In a plush Yoga Studio we removed our shoes and started our walk! A walk into human mechanics as it is rarely explored. Along the way I had the gracious help of Anita Furbush PT, PRC as a lab assistant. Mike DeMille DPT, PRC and Eric Menchi CSCS, PRT pitched-in as well to offer a hand in the labs too! So many are mystified when I mention to them that Ribcage and Diaphragmatic dysfunction is a root cause of many orthopedic diagnoses. But following a Postural Respiration class they all agree that it is not only possible but the most likely reason for multiple orthopedic diagnoses! I invite you all to attend this fascinating class and explore the world of human asymmetry as it has never been explored before. PRI Nation is sweeping the nation!

I remember initially meeting Dr. Davidson in February of 2014, in Philadelphia, at a Cervical Cranial Mandibular Restoration course. It was his first PRI course. He has attended 20 PRI courses since that date and has helped countless students and individuals understand the human behavior from an adaptative, evolutionary and survival perspective. After looking at his material for his presentation on “The Resistance as Reference, and the Loss of Authentic Environments” I know anyone who has an interest in “authentic elements of resistance” will not want to miss his perspectives on how to recognize it and benefit from it. “With the loss of resistance built into our environments, many of us are losing a sense of purpose, have no clear direction in life, and feel unsatisfied’. Pat is an open –minded, liberated, inquisitive and receptive individual with a background that makes him highly qualified for this symposium and topic. And I can still remember his 2014 symbiotic smile and look forward to seeing it again in 2018! Learn more about the 2018 Interdisciplinary Course here.

I had the privilege of teaching at Advance Physical Therapy in Chapel Hill this past weekend. I had a wonderful time teaching this group of clinicians over the St. Patrick’s Day weekend with March Madness in full swing. The big takeaways this past weekend from the class perspective were the following: 1. the power of respiration and synchronization of both the pelvic and respiratory diaphragms. 2. The A-B-A model of evidence base practice implemented in the clinic with PRI concepts. The “A” objective PRI tests then the “B” of PRI non-manual techniques and then the change to the “A” after the technique was implemented. 3. Truly understanding what the PRI objective tests are and how they can assist the clinician to picking PRI non-manual techniques that best assist the patient. This class was inquisitive, passionate, and open-minded. It was a great joy to mentor you in your PRI journey. To the staff of Susan, Joe, Jean, Lisa, Beth, Molly, and Nancy thank you, thank you, and thank you. Your organization of the room set-up, snacks, assisting us to get manuals copied when a boxed didn’t show up and most importantly for your passion of PRI, I am grateful and humbled.

Postural Respiration – Lima, OH (pronounced “Lie-ma”, like the bean). The course was hosted by Lima Memorial Wellness Center, inside the bright and spacious YMCA. We had clinicians from a range of fields (PT, PTA, OT, ATC, student, exercise physiologist, and chiropractor) and experience (from first course to twelfth). A good deal of time was dedicated to lab, where attendees gained solid familiarity on how to inhibit over-active chains of muscle through both manual and non-manual techniques. It was helpful to have seasoned PRI course-goers stepping in to offer their clinical pearls (Alex Maag, DPT, PRC; Mary Ann Arellano, PTA; Chris Fortman, PT; Melissa Miller, PTA; and Beth Trombley, DPT). Attendees learned the value of blowing up a balloon and filling a left posterior mediastinum and the meaning behind synchronize and separate to achieve optimal gait mechanics through obtaining, and maintaining, a L ZOA.

Thank you to our models John Hollenbacher, OTR/L and Lisa Overman, PTA, who kindly allowed us to evaluate their patterned bodies and who gamely performed non-manual techniques that would challenge any Olympian! Thank you also to our reader, Nancy Siatkosky, DPT, who was nearly flawless (good thing everyone was paying attention and didn't try releasing the subclavius with their derrier!). Many thanks to Alex Maag for fulfilling many roles, from lab assistant and A-V tech support to keeping this instructor well-fed, and to all of the clinicians of Lima Memorial Hospital: Ronnie Ballard, PTA; Cassie Frantz, DPT; Richard Garber, ATC; Mary Jump, PTA; Melissa Miller; Lena Moore, PTA; Nancy Siatkosky; Casey Siefker, PT; Jennifer Smith, PT; and Desiree Wallace, PTA. As someone who has hosted courses in the past, I know the effort that is put forth to make everyone comfortable – including the extra coffee on an oh-so-early Sunday morning😊 your hospitality was superb!

In the fall of 2017, Jen was contacted by Jessica Tidswell, PT, ATC, SCS, PRT, assistant professor for the Physical Therapy and Athletic Training programs at the University of Utah. We have requests for information, providers, course questions and many other inquires on a daily basis, but the request Jess had was different. She has the pleasure of working closely with the graduate athletic training students, and instructs several graduate courses while remaining clinically active through the University. She typically offers an Independent study as part of this course work and had a strong desire to somehow include PRI concepts as part of her 2017 fall semester. Jess has taken several PRI courses including all three primary courses as home studies, and after her conversation with Jen it was determined that our home study would be the perfect fit. Jess decided to focus the entire semester’s independent study on Pelvis Restoration. We were thrilled to have our course be the focus of a graduate level review and after a few more conversations with Jess, we had them up and running. Not only was this the first time the Home Study was used in this way, but she later decided to follow-up the fall semester this spring with the Myokinematic Restoration course for another semester long independent study. Jess is a pioneer in more ways than one. Receiving a Doctor of Physical Therapy in 2002, Jess was clinically active for several years before deciding something was missing. Her background and passion in Exercise Science and Athletic Training led her to return to school, as a student, seeking her second Bachelor’s degree in Athletic training. Jess recently completed her PRT credentialing and is the first DPT, ATC to be credentialed in our Postural Restoration Trained™ (PRT) credentialing program. Highlights from several of the students who were a part of this Independent study can be read below, and an interview of PRT Jessica Tidswell can be read HERE.

Thank you to Jess, and the students from the University of Utah, who continue to seek a better understanding of our science, and make these semester reviews a success. If any educators are interested in setting up similar Independent Study courses, please feel free to contact me!

Student Reviews:

Upon signing up for this semester-long independent study Pelvis Restoration home study course, how much knowledge of Postural Restoration® did you have if any? If this was your first exposure to the science, what stood out the most to you about this novel way of looking at human asymmetry?

“This was my first exposure to Postural Restoration, and being able to look at postural muscles in a different way and how they affect the innominate bones changed the way I treat my athletes and improved my outcomes.” - Bryan Erspamer, ATC

“Prior to signing up for the independent study, I had previously taken the in-person postural respiration course. I was first exposed to PRI from an athletic trainer and mentor during my first job after graduating from undergrad. It immediately peaked my interests due to its holistic view of the human body. The concepts described by the institute on how our inherent asymmetries relate to dysfunction were initially hard to grasp as a young clinician. However, the more I asked questions and critically applied the science, the more that I knew this was going to be an essential part of my career. Initially, much of my treatment focus was on the location of the injury itself. The Postural Restoration Institute provided the big picture and not only altered how I care for my patients, but also totally revamped the way I view human anatomy.” - Chris Michaels, LAT, ATC

“The semester-long independent study of Pelvis Restoration was the first time I had been introduced to PRI. I appreciated how the PRI approach has a strong focus on the kinetic chain bilaterally. PRI showed a unique perspective to optimize total body function by addressing the inhibition and facilitation needs on each side of the body individually.” - Julia Villani, ATC

As you got closer to the end of the semester did the course material challenge your thinking, or way of looking at certain injuries or dysfunction, that you encounter as an Athletic Trainer? What are some of the ways that you plan on implementing this material, or how do you see this material being utilized in your setting in the future.

“PRI changed the way I treated my athletes, I went from using a lot of muscle energy techniques for short term relief, to putting athletes on PRI programs to actually resolve the underlying issues. Working with hockey players, I see a lot of chronic hip and low back pain. Due to the mechanics of skating hockey players are prone to being in a PEC pattern, so I see myself using PRI on a broader scale in the future, implementing these techniques team wide.” - Bryan Erspamer, ATC

“The course material throughout the semester was both challenging and eye opening. Learning about the intricacies of pelvic motion, how pelvic position relates to asymmetry and dysfunction, and how I can use the Postural Restoration® science to make a long term impact on my patients was career altering. I work with college softball players and often times they complain of shoulder pain, but after taking a more extensive history, I learn that they also suffer from chronic low back and/or knee pain. While doing exercises on the lower extremity as part of an upper extremity rehabilitation program can often seem strange to my athletes, after taking the pelvis course, I know that this approach is essential for long term, total body health. In the future, I hope to implement PRI as a part of my pre-participation physical examinations to screen my athletes and get them started on a Postural Restoration® program prior to competition.” - Chris Michaels, LAT, ATC

“Absolutely, my view of overuse injuries and dysfunctional movement has changed. Now, I not only address the chief compliant but I take a much more detailed look at the pelvis and how it may be influencing the issue. I plan on incorporating PRI techniques in most of, if not all of my overuse injuries and dysfunctional movements. I have yet to find an athlete that would not benefit from some level of PRI exercise.” - Julia Villani, ATC

Overall would you recommend an independent study PRI home study course to other graduate students? How did your view of the science of Postural Restoration® change from the beginning of the semester, once you had completed the course? (Any additional feedback or comments are welcomed below)

“I would absolutely recommend a directed independent study focused on PRI to any graduate level AT. I feel that this was the best way to be introduced to PRI as we had Jess directing us and always willing to answer any questions we might have had. The environment also allowed us to work together as graduate students and better understand the language, the science, and the implementation of PRI. As the semester progressed and I got more of a grasp on the concepts and science behind PRI, I was able to start implementing PRI programs in the clinic. In the independent study set up, I was always able to address any questions or problems I might have had with Dr. Tidswell.” - Bryan Erspamer, ATC

“I would strongly recommend the independent study PRI home study course to other graduate students. Taking this course alongside my classmates has created a collaborative learning experience that extends beyond the classroom. Throughout the semester, my classmates and I would meet in the clinic to either talk through questions we had from the course, or practice the special tests and exercises we learned during class time. I think the best part of taking this course as an independent study was that even once the class ended, a sort of PRI culture was created amongst the students who took the class. We all still make a point to check in with one another to discuss how we are applying the material and how we might be able to improve the way we utilize the concepts with our patients. We also have an online group where we share research, videos, and other useful material related to PRI. The independent study PRI home study course has fostered an environment of continuous learning and has changed the way we treat our patients.” - Chris Michaels, LAT, ATC

“I have no hesitation recommending a home study course to other graduate students. In my experience, newly certified athletic trainers have a limited number of tools in their toolbox to address overuse injuries and dysfunctional movement. This course not only helped me deepen my knowledge of pelvic anatomy, but also how imbalances in the core and pelvis reflect through the kinetic chain.” - Julia Villani, ATC

Ron Hruska will be presenting a free live webinar through the AAPMD,the webinar will be 7:00 PM - 8:00 PM (Central Time). You can register HERE. The webinar is available free of charge if you watch it live, recordings are available to AAPMD members at no charge. Non-members can purchase recordings for $35.00 or 3 for $75.00. Read more about Ron's talk:

You expanded the dental arches, inserted a well fitted oral appliance for sleep and/or TMJ …. the patient is better ….. but something is still missing. It could be airway mal-alignment due to cervical dysfunction, cortical visual processing, asymmetrical postural patterning or a combination of all three. Did you know that the way your airway functions and the way you breathe reflect the foot you like to stand on? The position of the neck affects the airway.

Ron Hruska, founder of the Postural Restoration Institute, will introduce you to new and exciting concepts that incorporate vision, posture, and occlusion for more optimal airway function. Any practitioner treating airway must attend this webinar.

Ron Hruska, MPA, PT, has a strong interest in myokinematic and biomechanical influences on postural and peripheral adaptation patterns. His 32 years of clinical experience assists him with direct patient interventions based on specific examination and evaluation data that best reflects neuromechanical stability, trunk symmetry and respiratory balance. He lectures extensively and consults regularly with physicians, physical therapists, optometrists, dentists, and other health care providers across the United States and internationally on patterned postural position and pathology and his approach of restoring symmetrical balance using PRI principles. His reputation has led to consultations with collegiate and professional athletes from a variety of arenas, states and countries. He is a graduate of the University of Nebraska Medical Center, Division of Physical Therapy. He currently is a member of the American Physical Therapy Association. Ron serves as a Biomechanical Consultant to the University of Nebraska-Lincoln through the Division of Athletic Medicine. He has patented Prism and Priori PRI Aquatic systems. He is co-founder of PRI Vision, LLC. He is Director of the Postural Restoration Institute ® and consults and practices at the Hruska Clinic, Restorative Physical Therapy Services, and PRI Vision Clinic in Lincoln, Nebraska.

Also special thanks to Nancy Hammond, PT, PRC for all her coordination and support getting this course to St. Louis.

We had an AWESOME group! Thank you to all that attended! We introduced the PRI Science and covered key principles to shape trunk stabilization and empower proper grounding and single leg control. Lots of lab time was valued on Sunday. Our focus was dedicated to helping attendees feel and connect with the programming material and learn how to organize the pelvic thorax mechanics to optimize proximal control. This course does a great job tying key concepts together and helping to get our clients moving in and out of movement patterns. So grateful for this group! It really was a great weekend!